applied systems improvement processes · • 5 principles of csi • value & waste • process...
TRANSCRIPT
1
Applied Systems Improvement
Processes
MTS – Day 2
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
Yesterday’s programme
• 5 Principles of CSI
• Value & Waste
• Process Mapping
• Leadership & Teams
• Lean simulation
– Batch sizes
– Quality
– Improved flow
– Matching resources with demand (takt time)
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
Today’s programme
9.00am Review of Day 1 and simulation activity
9.15am Introduction to problem solving tools & visual management
10.15am Project management & action plans
11.00am Coffee
11.15am Managing change and sustainability
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Clinical Systems Improvement
www.warwick.ac.uk/go/csi
TodayTodayTodayToday’’’’s Objectivess Objectivess Objectivess Objectives
By the end of today’s session you will:
• Have continued to challenge the way that you and your colleagues think and act in the workplace
• Have gained an understanding of project management, problem solving & visual management
• Have gained an appreciation of the integration between patient safety & systems improvement
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
“In God We Trust …
- all others must bring data”
W Edwards Deming
Problem Solving
Clinical Systems Improvement
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Describe a Problem
As a variation from standard
Speak with Data
Do it yourself
Or see the operation in progress
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Clinical Systems Improvement
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Problem Solving
The actual place
The actual workstation
The actual thing
The actual facts
The actual peopleDon’t ‘problem solve’ in the office!(you can’t see 5S, SOPs, etc.Memory is short….)
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
Attitudes
Not
“we tried that before”
“it didn’t work”
“it can’t be done”
“why should I ?”
“it’s not my problem”
But
“we can always get
better”
“we can do it”
“lets work out a solution
together”
“it’s great to see our
improvements in place”
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
Problem Solving Steps
Concern
Problem definition
Data collection
Change Analysis and Barrier Analysis
Root Cause Analysis
Countermeasures identification
Countermeasures implementation
7 Tools Methodology
3C’s: Concern, Cause, Countermeasure(plus Who, by When, PDCA stage )
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Clinical Systems Improvement
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A well-defined problem
It focuses on the gap between what is and what should be
It states the effect
It is measurable
It avoids ‘lack of’ and ‘no’ statements (that imply a solution)
Can include the significance of the effects
Ammerman (1998)
Clinical Systems Improvement
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Problem Analysis:
Task Analysis & Data
Go to and walk the area
Draw a map
Collect the 6 Honest Men
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
The 6 Honest Serving Men
– What do we need to do? Target/measure
– Why do we need to do it? Objective/aim
– When does it need to be done? Time frame
– Who should do it? Person/role
– Where should it be done? Location/place
– How ought it to be done? Method/logic
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Clinical Systems Improvement
www.warwick.ac.uk/go/csi
6 Honest Men with Is/Is NotIs / Is Not was developed by Kepner-Tregoe
What
(Why)
When
Where
Who
(How)
Is Is Not So...
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
6 Honest Men with Is/Is NotIs / Is Not was developed by Kepner-Tregoe
What
(Why)
When
Where
Who
(How)
Is Is Not So...Not 100%
satisfied with course
Too fast Content
Start time End time
Too cold Seats, visibility
John Norman
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
Problem Analysis:
Change Analysis & Barrier Analysis
Change analysis’ 3 Questions:
– What was different about this time from all other times?
– Why now, not before?
– Why here, not there?
Barrier analysis
A control barrier is an administrative or physical aids or devices to ensure safety or enhance performance. For example,
barriers to reduce road deaths include seat belts, speed
limits, driver’s licence, airbags
The method first identifies all barriers, then evaluates their
effectiveness or use, and how or why it failed. Ask what
barriers are necessary to prevent recurrence.
After Max Ammerman,
The Root Cause Analysis
Handbook, Productivity, 1998
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Clinical Systems Improvement
www.warwick.ac.uk/go/csi
Problem Analysis:Root Causes
A root cause is the most basic reason for a
problem which, if corrected, will prevent
recurrence of the problem. A root cause is
different from a presumed cause and a
contributing cause.
Methods – include:
Barrier analysis
Fault tree analysis
After Max Ammerman,
The Root Cause Analysis
Handbook, Productivity, 1998
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
The 5 ‘Whys’
All problems have an immediate cause. This cause is usually a symptom – not the real problem
Using the 5 whys the root problem is identified
Only by identifying the problem can it be prevented
If a symptom is treated it could worsen the problem!
Use this 5 whys with brainstorming and as a way to gain buy in from the team
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
5-Why Analysis
What is it?
Asking ‘why’ several times over
Used to identify the root cause – help to see beyond the symptom of the problem
When do we use it?
To get to the root cause of a problem with an unclear solution
To understand why a situation might be getting worse
Why? Why? Why? Why? Why?Why? Why? Why? Why? Why?
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Clinical Systems Improvement
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5 Whys
Addressing the root cause should provide a sustainable solution (rather than fixing the
symptom)
Long term solution v short term fix
Never accept first reason – try and probe
behind the answer
If feels too confrontational – ask ‘How does
that happen” x 5 times
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
5 Whys
Problem
Why?
Why?
Why?
Why?
Why?
Why?
Why?
Why?
Why?
Why?
Why?
Problem Root causeWhy? Irrelevant do not explore further
Why?Found root cause look no further
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
5 Whys
Discharge
Was delayed
For 2 days
Patient
Needed a
Cardiac
Referral –
Which
Could not
Happen
Until 2 days
later
The cardiac
Referral
Note was
Not sent
Out until
The day of
discharge
The referral
Was not
Handed
Over
During the
Shift change
When it was
Handed over
Not known
Patient to be
Discharged
Next day
Oversight
During shift
handover
No expected
Date of
Discharge
given
No handover
Checklist
To prevent
oversights
No system
For capturing
Expected
Date of
Discharge &
Displaying it
Problem
Why? Why?
Why?
Why?
Why?
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Clinical Systems Improvement
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Need to prioritisethe issues
Need to identify those solutions that will have greater impact for minimal effort
Resources will not allow us to implement all
the solutions at once
So need to prioritise our efforts
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
Problem/countermeasureAnalysis
Aids project management
Assist to systematically list and prioritise problems & solutions
Provides a timeline & identifies
responsibilities
Keep visible and accessible
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
Cost-benefit Analysis
T T
T T
BenefitHigh Low
Co
st
Hig
hL
ow
OS
OS
OS
OS
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Clinical Systems Improvement
www.warwick.ac.uk/go/csi
Cost-benefit Analysis
T T
T T
BenefitHigh Low
Co
st
Hig
hL
ow
OS
OS
OS
OS
Low cost but high
Benefit area
Low cost but low
Benefit area
High cost but highBenefit area
High cost but lowBenefit area
Team – no outside support
required
require outside
support
1 2
3 4
5
6
7
8
Clinical Systems Improvement
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Problem/Countermeasures
No Concern/ideaRaised
by
Countermeasure/Action
Resp Timing StatusSign
off
Shade one quadrant each for1. Responsibility identified
2. Trial done3. Discussion had4. Implementation completed
1
23
4
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
Measures of Success
Try and devise TEN key measures that will demonstrate:
• the success you are having in your job,
• the value you are giving to your customer
• the waste you are eliminating.
Handout-ten measures
10
Clinical Systems Improvement
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Visual Management
“I hear, I forgetI see, I remember
I do, I understand”
Clinical Systems Improvement
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Visual Management
What is visual management?
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
Visual Management
There are two forms of visual management:
Visual organisation in the ward area to make it easier to visualise (operational):� what is happening – flow of patients in the ward (ward board)
� If a problem occurs – equipment missing
� Guidance and control – where to put trolleys, maximum stock levels
Graphical data and information� Day to day operational data – shifts, meal rounds, medicine
rounds, discharge planning
� Reference data –ward blueprint, standard operating procedures
� Planning information – holidays, rotas, training
� Project progress sheets – problem follow ups/ corrective actions
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Clinical Systems Improvement
www.warwick.ac.uk/go/csi
Visual Management
Has two main functions:
To manage the process
� To maintain the current operations
� Identify and communicate abnormal conditions
To improve the process
� Operations – defines and communicates known standards
� Communicates – allows informed improvement
decisions to be taken
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
Visual Management
Visual Management is the back bone of systems improvement
It builds on all tools like 5S, PDSA, SOPs etc to enable
– System Maintenance (maintain current position) and
– System Improvement (move to ideal state)
Visual Display versus Visual Control
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
Visual Management
Visual management involves the clear display of charts, lists, process etc. so that
all staff are continuously reminded of all
elements that make safety, quality, cost
and delivery of care successful.
Important to remind ourselves where we
started from…(storyboards)
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Clinical Systems Improvement
www.warwick.ac.uk/go/csi
Sort
Straighten/Simplify (Set in order)
Shine
Standardise
Sustain
5 S standards
Not
Used
Sustain the gains
1 2 3 4 5
5s used to create a highly visible and
organised working area
Handout-5S
Clinical Systems Improvement
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Sort (Organisation)Separate what is needed from what is not needed. Keep only what is needed, only in the amounts needed, and only when it is needed. Remove unnecessary items.
Not
Used
S1
Set in Order (Orderliness)S2Arrange needed items so they are easy to find and use. Label items so their storage sites are easily understood by anyone. “A place for everything and everything in its place.” Implement visual control. M
ake things
easy to find and
use
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
Remove dirt, mess, clutter and dust from the workplace. Keep everything clean and tidy.
Sweep & Shine (Cleanliness)S3
Clean the work area
Make sure that Organisation, Orderliness, and Cleanliness are being maintained and incorporated into everyday activities.
StandardiseS4
Operate according to standards and procedures
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Clinical Systems Improvement
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Making a habit of properly maintaining correct procedures and continuously improving workplace conditions.
SustainS5
Sustain the gains
Clinical Systems Improvement
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BEFORE 5S
AFTER 5S
Source: NHS Institute
Clinical Systems Improvement
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More appropriate stock levels – based on clinical need
BEFORE 5S
AFTER 5S
Source: NHS Institute
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Clinical Systems Improvement
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Endoscopy team undertaking a 5S activity to create a visible, high performing workplace
Excess stock that is not required (Sort) – How much does this cost to
keep?Source: NHS Institute
Clinical Systems Improvement
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All this was in the cupboard but what not required – over 60 packs
Endoscopy Room 1 – Hereford Hospitals
Source: NHS Institute
Clinical Systems Improvement
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Endoscopy Room 1 – Hereford Hospitals
BEFORE AFTER
Sort, set in order, clean, standardise
Source: NHS Institute
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Clinical Systems Improvement
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Stock levels reviewed and standardised. Clearly labelled
Sort, set in order, clean, standardise
Endoscopy Room 1 – Hereford Hospital
Source: NHS Institute
Clinical Systems Improvement
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Where can you use 5S?
Have a go at using 5S to organise your e-mail inbox
Handout lean e-mailing
Clinical Systems Improvement
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Visual Management
Should be integrated into 5S and Standard work
Aim is to be able to gain maximum operating information and control without having to go off the ward, or go into a computer system
16
Clinical Systems Improvement
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Advantages of Visual Management
Simply provides rules/guidance for daily working (ward boards etc)
Simply provides information to stimulate focused improvement and decision making (transparent)
Identifies and tracks problems/issues enabling root cause improvement –reduces errors
Informs all about current performance and trends (see how we are doing)
Assists those new to the system (Bank and Agency, Locum, Junior Doctor etc) to learn quickly
Contributes to sustainability
Source: Rich et al., 2006
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
Operational Visual Management
People – a skills matrix (or I L U O chart)
Material – Stock replenishment, footprints
Maintenance – A red tag board showing all outstanding concerns
Problem solving boards and Andons (stop the line authority)
5S – Charts, audits
SOPs – Visual if possible, T-Cards (coloured cards – reversed when checks completed)Source: Rich et al., 2006
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
Operational Visualisation
3 boxes max.
Rich et al, 2006
17
Clinical Systems Improvement
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ILUO Chart
Name Mapping 5S Problem Mentoring
Solving
J BloggsI I I
T Smith L L U O
I
I I L
L Jones
P Clark
U U O OR Thomas
Projects
Meals
Well organised ward, meals, medicines
Well organised ward
Medicine round
Meals, well organised ward, toolkit
Key
I
L
U
Not yet started
Awareness, education
Participated in activity, completed with support
Led an activity
O Able to train others
Source: Adapted from Rich et al., 2006
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
Communications Board Measures
Displaying data relating to daily operating and the strategic vital few (limited number of measures)
Usually the responsibility of the area supervisor/manager
to update
Is the basis for understanding if the system design is fit for purpose and enables responsiveness to change (does the system deliver the desired outcomes?)
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
Visual Management
Visual Management is the ‘Litmus test’ for Lean (Bicheno, 2004)
If you find that the following are not immediately apparent and up to date
Standard Work
Work (patient) flow
Problem Solving Process
Quality
Maintenance
Safety
Then it is unlikely the organisation is ‘lean’
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Clinical Systems Improvement
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Examples of visual Examples of visual
managementmanagement
Safety, Quality, Cost & Delivery should be the main measures displayed
Handover times, meal round times etc – regularly reviewed/graphed to avoid slippage
Skills matrix – beginner to instructor
Employee suggestions
5S – display area for responsibilities & 5 minute clean up plans – use shadow boards
Storyboards – stages of RIE events – successes
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
What the patient display board looks like
The consultants are
colour-coded so you can see who is caring for which
patient
The board is a map of the ward so you can see
the physical location of the patient
A traffic light
system is used for patient status
Magnets are used for patient status so they can be easily added
and changed
The ward
team areas are clearly
marked
Board is now used in shift handover – time cut from ~90 min
to ~60 min
Used for quick patient information reference
Allow staff to work backwards from EDD
The nurses on each
team are listed on the board
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
A ‘good’ patient display board
3
Status
8 Feb
9 Feb
CBC, Chem
X-ray
CBC
CT Scan
Bed #
N Ahmad
J Smith
I Taylor
C Stone
EDD
Dr.
XD
r. Y
Dr.
Z
Name* Tests done –
Waiting for Results
Tests to be done –
date due
Discharge Steps
A Adams
B Brent
C Clarke
M Stewart
T Walton
A Waters
1
2
3
4
4
5
6
7
8
9
8 Feb
12 Feb
8 Feb
8 Feb
9 Feb
X-Ray
UA
CT Scan – 8 Feb
CBC – 7 Feb
Status
8 Feb
9 Feb
CBC, Chem
X-ray
CBC
CT Scan
Bed #
N Ahmad
J Smith
I Taylor
C Stone
EDD
Dr.
XD
r. X
Dr.
YD
r. Y
Dr.
ZD
r. Z
Name* Tests done –
Waiting for Results
Tests to be done –
date due
Discharge Steps
A Adams
B Brent
C Clarke
M Stewart
T Walton
A Waters
1
2
3
4
4
5
6
7
8
9
8 Feb
12 Feb
8 Feb
8 Feb
9 Feb
X-Ray
UA
CT Scan – 8 Feb
CBC – 7 Feb
Patient’s
location
Patient’s
name
Consultant’s Name
Estimated
discharge date
Current status
of the patient
Investigations to be done
Requirements for discharge
A ‘good’ patient board contains all the information required for its
specific purpose, e.g. shift handover or discharge management
A ‘good’ board is an importantpart of shift handovers and
discharge management. Please see the modules ‘Shift Handover’and ‘Discharge Management for
additional detail.
19
Clinical Systems Improvement
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Activity
What forms of visual management are used within your area of work?
What 10 measures could you employ and
display on your office board?
Clinical Systems Improvement
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Project Management:
Allocating time & resources
Clinical Systems Improvement
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Introduction toProject Management
Project management skills essential for those who manage complex activities &
tasks
Project management concerned with
anything: people, equipment, storage,
buildings, staffing & management, finance,
administration, training, quality of care, patient safety etc…..
20
Clinical Systems Improvement
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Project management process
Agree precise specification for the project• Could adapt project poster template
Plan the project – time, team, activities, resources, financials
• Useful tip to work backwards from the end aim, identifying all the things that need to be put in place and done
• Brainstorming event will help gather most of the points & issues
• Establish the relationship and links between the issues/activities (some might run in parallel)
• Most projects do not complete on time – so don’t plan a timescale that is too ambitious. Ideally plan for some slippage if possible
Communicate the project plan to your team
Clinical Systems Improvement
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Project management process
4. Agree and delegate project actions – once project starts ensure at project team meetings updates and actions are recorded (and the Gantt chart updated as necessary).
Manage, motivate, inform, encourage and enable the project team
Check, measure, review project progress, adjust project plans and inform the project team and others
7. Complete project, review and report on project performance, give feedback and thanks to project team
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
Critical path analysis
Is a logical and effective method for planning and managing projects
Start by noting down all the issues,
resources and activities in a rough order
– e.g. making a cooked breakfast
Note that some activities might happen in
parallel
Timescales can be applied to each activity
21
Clinical Systems Improvement
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Critical path analysis
Start
Prepare ingredients
Prepare Cooking
equipment
Assemble
Crockery, Utensils &
condiments
Serve
Warm plates
Lay table
Toast bread
Poach eggs
Grill bacon & tomatoes
Clinical Systems Improvement
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Gantt Charts
This can be constructed using MSExcel or a
similar spreadsheet
Every activity has a separate line
Create a timeline – usually weeks or possibly
months
You can colour code the time blocks to denote the
type of activity
You can schedule review points/meetings etc
Gantt chart can be used to track progress
Clinical Systems Improvement
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Gantt Charts
You can use Gantt charts to report on planned versus actuals
But they don’t show the importance and
inter-dependence of related parallel
activities - the necessity to complete one
activity before another can begin – need to
use in conjunction with critical path
22
Clinical Systems Improvement
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Serve
Toast bread
Poach eggs
Lay table
Grill
tomatoes
Grill bacon
Warm plates
Assemble crockery,
utensils etc
Prepare
equipment
Prepare ingredients
Gantt ChartActivity Time - minutes
Clinical Systems Improvement
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RACI approach to project management
The ‘RACI’ model is used as a framework for project management. This model is used widely for both industrial and academic projects.
It states for effective collaboration, communication and coordination there is a need to establish who will be responsible, will be accountable, needs to be consulted and be kept informed.
Clinical Systems Improvement
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RACI
Responsibility for a task refers to doing it or ensuring that it is done.
Accountability refers to the person who ensures that the tasks are done.
Consultation applies to a person/ team who provide an input or some involvement in the task. Can include a project team or steering committee
Information – how the outcomes of the project will be disseminated and to whom?
Can add these first three columns to your Gantt chart
23
Clinical Systems Improvement
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JunMayAprMar
Project
team
Monthly
meetings
DRLC &
AE
Disseminate project
outcomes
DRAction -
DRSWCompile
countermeasures
DRSECost benefit analysis
DRSWCompile process map
DRAEVideo
process
Ward
mgrDRSWWaste walk
OctSepAugJulFebJanConsAccountability
RespActivities
Clinical Systems Improvement
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Coffee break
11.15am Managing change and
sustainability12.00md Systems Improvement & Safety
1.00pm Lunch
Clinical Systems Improvement
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Organisational change
Models of change:
e.g. Lewin’s – unfreeze, change & refreeze
Planned versus emergent change
Span of control
24
Clinical Systems Improvement
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Sustainability
Good
Poor
BeforeTime
Now Later
Idea
PDSA
PDSA
PDSA
Pe
rfo
rma
nce
Source: Improvement leader’s guide: Sustainability
Clinical Systems Improvement
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Sustainability
“When new ways of working and improved outcomes become the norm” (NHSI 2007)
Maintain and hold the gains
Up to 70% of implemented organisational changes in industry fail (Daft & Noe, 2002; Beer & Nohria, 2001)
Up to 33% of health changes fail (1 in 4 fail to achieve objectives)
Initiative decay or improvement evaporation effect.
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
NHS SustainabilityModel
Is a diagnostic tool that is used to predict the likelihood of sustainability for your improvement project(s)
Guide teams to things they could do to increase the chances that the change for improvement will be sustained.
Best time to use the tool– Design or selection of initiative
– Time of initial pilot testing
– A few weeks after the improvement has been implemented.
www.institute.nhs.uk/sustainability
25
Clinical Systems Improvement
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Sustainability
1. SupportiveManagementStructure
2. Structures to foolproofchange so that
embedding takes place.
e.g. change inpolicy, provision
of resources
3. Effective delivery supported by
robust, transparent
feedback systems +
PDSA cycles
4. Effective collaboration &shared sense
of the systemsto be improved
5. Culture ofimprovement with engaged
staff & patients
6. Formal
capacity –building
programmes
Training & application ofimprovement
methods
Source: Improvement leader guide: Sustainability
Clinical Systems Improvement
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NHS SustainabilityModel
Training & involvement
Attitudes
Senior Leaders
Clinical Leaders
Fit with goals &
culture
Infrastructure
Benefits
Credibility of
evidence
Adaptability
MonitoringProgress
10 Factors – sustaining
Change in healthcare
Numeric value for
each factor
StaffOrganisation
Process
Clinical Systems Improvement
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Enablers of CSI
Encourage and support team decision making
Make sure that there is time (10 minutes)
dedicated to maintaining 5S standard – (first
three Ss covered in training, final 2 elements can
only be adhered to on a day-to-day basis)
This can be done at the start or end of a shift or
during a quieter period
Team to create a weekly 5S check sheet that is
signed off by managerSource: Bateman & SMMT (2001)
26
Clinical Systems Improvement
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Enablers of CSI
Ensure there are measures to monitor improvements – at ward level.
These need to be visible and kept up-to-
date.
Periodically review that these are still
appropriate and the data are being
presented in a useful way.
Source: Bateman & SMMT (2001)
Clinical Systems Improvement
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Enablers for Continuous Improvement
Dedicated person to co-ordinator SI activities
Senior managers should be involved in SI activities (and stay focus on SI)
Ensure all new procedures or activities are formally introduced to all staff (include in induction?)– Not everyone will be involved in improvement
activitiesSource: Bateman & SMMT (2001)
Clinical Systems Improvement
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Who is responsible for sustainability?
How long should a change be sustained?
Can you measure sustainability?
Do you perceive any issues around sustainability?
If so, how do you think these can be
overcome?
27
Clinical Systems Improvement
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Video
Make notes on any learning from the scenario in the video that can be applied
to the NHS
The worksheet may help you
Please try to develop a root cause analysis
approach
Handout- Kegworth
Clinical Systems Improvement
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Video
Clinical Systems Improvement
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Lunch break
1.45pm Systems Improvement & Safety
2.15pm Lean meetings2.30pm Strategy & policy deployment3.00pm Tea
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Clinical Systems Improvement
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Group discussionImprovement and Safety
Clinical Systems Improvement
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Group discussion –lean meetings
Handout- lean meetings
Clinical Systems Improvement
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Strategy and Policy Deployment
29
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
Tea break
3.15pm Facilitated discussion - future application of learning 3.45pm Summary, feedback & questions 4.00pm Close
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
Future application of CSI
Completion of handout – reflection
What will you change/challenge
Your 10 noticeboard measures
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
Organisation:: Contact Name: Last Updated:
Project: Problem definition sheet
What do we need to do? What is the problem?
What wastes exist? Are they effects or root causes to the problem?Target/measure (vital few) and how will these help us know
that the problem is resolved?
What is the Current State?What is the Desired Future State?
Why do we need to do it? Objective/aimOne sentence statement plus two or three objectives/hypothesesSpecific
Measurable – data (quantify)Achievable
RealisticTimeframe
Customer identification & value
Who is the customer(s) of the project/process area
And what do they value (wants, needs, demand)?
When does it need to be done?
Timeframe
What does the team think will be achieved in the
CSI time frame?
Who should do it?
Members of the team & roles
Where should it be done?
BoundariesArea of improvement
How ought it be done?
Method
Available as handout
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Clinical Systems Improvement
www.warwick.ac.uk/go/csi
Models for Improvement
What are we trying to accomplish?
How will we know that a change is an improvement?
What change can we make that will result in improvement?
Plan
Do
Study
Act
Source Langley et al., (1996), The improvement guide: a practical approach to enhancing organisational performance.
Handout-Nolan
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
Some of the barriers to clinical systems improvement
Lack of top management buy-in
Failure to align to organisational goals
Short term view
Unrealistic expectations
Middle management blockages
Sustainability issues
Too many measures
Lack of empowerment
Cultural inflexibility
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
Have we achieved course objectives?Challenge current way of thinking
Introduce the key principles of clinical systems improvement
Understand the role of value and waste
Introduce problem solving & project management tools
Consider how patient safety & CSI are closely aligned
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Clinical Systems Improvement
www.warwick.ac.uk/go/csi
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
Evaluation & expectations
Clinical Systems Improvement
www.warwick.ac.uk/go/csi
Questions:
Email subject: CSI MTS question
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forms and badges on the way out
Thank you & have a good journey home